Getting to Zero SF -- Retention Committee Retreat

September 11, 2015, AHP

NOTES

RBA Question 1: What is the end?

Identify the Population:

I. All HIV+ identified people in SF

What result is desired?

  • No deaths from HIV in SF
  • All are virally suppressed
  • Quality of life, including
  • Mental health
  • Housing
  • Substance use
  • Income & benefits
  • Food security
  • Socioeconomic
  • All are engaged in care as needed

II. All HIV- people in SF

What result is desired?

  • People in SF who are HIV- stay HIV-

Defining“Retention” and “Re-engagement”:

What is Retention?

  • Seen 2 times a year
  • On continuous ART
  • Annual or semi-annual labs
  • Tailored to the client‘s need
  • Not just medical retention – also mental health
  • Continuous engagement and
  • Supportive, stable housing
  • Case management
  • Strong connection with community

What is Re-engagement?

  • Prevention of missed visits
  • Engagement = seamless integrated care
  • Reducing barriers to care
  • Minimum standards for re-engagement
  • Connected to income, other services
  • “Any door is the right door” – supportive services serve re-engagement
  • “Treatment on demand” for treatment and wraparound services
  • Index of engagement – quality of life, satisfaction with care
  • Difficult for challenging (i.e., violent) clients

To identify indicators, consider what Retention & Re-engagement means for:

(1)Clients

(2)Providers

(3)Overall system (i.e., strong referral system; electronic medical records and communication between clients and providers)

What are the (potential) indicators of success?

  • Viral load
  • Visits/care marker
  • Less than 5% HIV+ not housed (NHAS target – SF could set bar higher)
  • Client satisfaction with care
  • Start with client – what would client identify as indicator?
  • Varies with special populations
  • Connection
  • Benefits, insurance (covers all 3 areas above: clients, providers, system)
  • Early engagement most important (6 – 12 months after diagnosis)
  • Being in care and access to other services: food, shelter, etc.
  • Cross indicator: Rapid
  • Relationship with provider (who listens to clients)
  • Access point for patient, i.e., social workers
  • Wraparound services in healthcare settings

RBA Question 2: How are we doing with the general population? Review data.

What stood out and what needs to be addressed?

  • Metrics? Need additional data:
  • Mental health, substance use folded into existing data to better define Retention & Re-engagement target and indicators;
  • People leaving prison
  • Where people are getting care and how successful systems are at R & R
  • Cross referenced data (i.e., gender & mental health; race & substance use)
  • Screening PHD9 PHD2 @ intake
  • Women and transwomen
  • Coordinated approach – other models as resource
  • Break down barriers within the system
  • Link data for more info
  • Patient satisfaction – indicator, retention tool
  • Need capacity analysis – “on demand” requires greater capacity
  • Cultural competency – the challenge of retention & re-engagement when you don’t see yourself in the care system

(Remainder of Day 1 agenda continued on the next page)

RBA Question #3 (large group)

3. What is the story behind the curve – what is actually happening and why?

  • What is contributing to progress?
  • What is hindering progress?
  • What are the root causes and which root causes are the most critical to address?

BREAK: over the break, choose which root cause working group to join

RBA Question #4 & #5 (Small groups by root cause)

4. What works to turn the curve? (Small groups to create recommendations)

  • What current strategies should be continued/scaled up?
  • What strategies should be discontinued?
  • What new strategies are needed?
  • What new strategies address the critical root causes?

5. Who are the partners that have a role in “turning the curve”?

RBA Question #6 (Large group)

6. What do we propose to do to turn the curve?VOTE

  • Leverage: How strongly will the proposed strategy impact progress?
  • Feasibility/reach: Is the proposed strategy feasible?
  • Specificity: Is the strategy specific enough to be implemented?
  • Values: Is the strategy consistent with the values of the community?

Next Steps